Antifibrotic therapy in nonalcoholic steatohepatitis: time for a human-centric approach

Nonalcoholic steatohepatitis (NASH) is projected to become the leading cause of end-stage liver disease and a reason for liver transplantation worldwide. The severity of fibrosis is the only known predictor of liver-related complications and mortality in NASH. It has been observed that regression of fibrosis leads to better clinical outcomes. Despite numerous clinical trials, there is no approved therapy for reversing fibrosis in NASH. However, advancements in understanding NASH susceptibility, its pathogenesis, multiomics profiling, electronic health record integration, and pharmacology techniques hold promise for developing effective antifibrotic drugs. Combining drugs to enhance efficacy and precision medicine approaches targeting genetic modifiers are emerging strategies for improving future clinical success.